Manager, Provider Performance ManagementHMSA • Honolulu, HI, United States

No longer accepting applications

Manager, Provider Performance Management

HMSA • Honolulu, HI, United States

8 days ago

Job type

Full-time

Job description

Lead provider performance management activities. Monitor technical, process, and business outcome metrics across all provider contract requirements and Service Level Agreements (SLAs). Recommend actions for improvement and drive continuous improvement. Oversee and manage staff.
Manage the performance governance aspects of provider services contracts. These activities include:
- Enforce compliance with the contractual SLAs and deliverables.
- Review and validate performance reporting.
- Capture potential value leakage and/or service level penalties.
- Coordinate implementation of SLA reporting automation.
- Generate dashboards and reports for executive level briefing.
Develop and measure provider network performance metrics and objectives, such as:
- Cost, quality, and accessibility reporting.
- Network reporting supportive of open enrollment and RFP's.
Ensure all regulatory network requirements are measured and reported according to listed requirements, such as:
- ACA, QUEST, Medicare, HMSA
Oversee data analysis functions that support contract negotiations and fee reviews.
Oversee out of network provider access strategies including:
- Single case agreements
- Network access partner solutions
Perform all other miscellaneous responsibilities and duties as assigned or directed.

#LI-Hybrid

Create a job alert for this search

Manager, Provider Performance Management • Honolulu, HI, United States

Similar jobs

Business Consulting - Healthcare Provider Operations - Senior Manager

EY • Honolulu, HI, United States

Full-time

At EY, we're all in to shape your future with confidence.We'll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go.Join EY and help ...Show more

Last updated: 2 days ago • Promoted

Senior Manager, Value and Access Solutions

Cardinal Health • Honolulu, HI, United States

Full-time

What Product or Services Marketing contributes to Cardinal Health.Product & Solutions Marketing defines product and market strategy, including customer need identification, market research, solutio...Show more

Last updated: 2 days ago • Promoted

Operations Manager 1, Multi-Service

Sodexo • EWA BEACH, HI, US

Full-time

With your leadership excellence, you’re ready to move up to the next level.Operations Manager 1, Multi-Service.Queen's Medical / Kahi Mohala Behavioral Health located in Oahu, HI.This small facilit...Show more

Last updated: 8 days ago • Promoted

Manager, Central Monitoring/RBQM Programmer - FSP

PAREXEL • Honolulu, HI, United States

Full-time

The Manager, Data Analysis, is responsible for overseeing centralized monitoring activities for global and/or complex clinical trials, ensuring the effective configuration, execution, and maintenan...Show more

Last updated: 2 days ago • Promoted

Director, Medicare P&L Management

Hawaii Medical Service Association • Honolulu, HI, United States

Full-time

Function as the leader and champion of the Medicare Stars Program, risk adjustment operations, and Medicare cost of care initiatives.Collaborate with internal and external stakeholders to establish...Show more

Last updated: 2 days ago • Promoted

Data Center Low-Voltage Vendor Management Senior Principal Technical Program Manager

Oracle • Honolulu, HI, United States

Full-time

Why Work as a Low-Voltage Vendor Management TPM at Oracle?.This role offers a unique opportunity to shape and lead a critical function within Oracle's Data Center Organization, influencing the succ...Show more

Last updated: 2 days ago • Promoted

Lead Program Manager - Data Center Operations

Oracle • Honolulu, HI, United States

Full-time

Bachelor's degree in Business, Engineering, Computer Science, or a related field; advanced degree preferred.Strong familiarity with project management software and methodologies such as Agile, Wate...Show more

Last updated: 2 days ago • Promoted

Central Monitoring, Manager

PAREXEL • Honolulu, HI, United States

Full-time

MUST HAVE AT LEAST ONE YEAR OF DIRECT CENTRAL MONITORING EXPERIENCE****.The Manager, Central Monitoring is accountable for centralized monitoring activities for global and/or complex trials, analyt...Show more

Last updated: 2 days ago • Promoted

RWD Engagement Manager

Norstella • Honolulu, HI, United States

Full-time

Location: Remote, United States.Why Norstella? Norstella unites market-leading companies that all have a shared goal of improving patient access.Each organization (Citeline, Evaluate, MMIT, Panalgo...Show more

Last updated: 2 days ago • Promoted

Director of Emergency Management

University of Hawai'i • Honolulu, HI, United States

Full-time +1

Office of the Vice President for Administration System.Title: Director of Emergency Management.Hiring Unit: Vice President for Administration.Location: Manoa Campus, Honolulu.Closing Date: Continuo...Show more

Last updated: 2 days ago • Promoted

Managing Director - IT Managed Services

Cayuse Holdings • Honolulu, HI, United States

Full-time

Job Title: Managing Director - IT Managed Services.Cayuse Company: Cayuse Commercial Operations.Department: Business Development/IT.The Managing Director of IT Managed Services is a dynamic, entrep...Show more

Last updated: 5 days ago • Promoted

Manager, Provider Performance Management

HMSA • Honolulu, HI, United States

Full-time

Lead provider performance management activities.Monitor technical, process, and business outcome metrics across all provider contract requirements and Service Level Agreements (SLAs).Recommend acti...Show more

Last updated: 2 days ago • Promoted

Manager Reimbursement Operations

Highmark Health • Honolulu, HI, United States

Full-time

This job plans, develops, and maintains operational processes and reporting related to group/provider facility and professional reimbursement configurations and other operational processes.Acts as ...Show more

Last updated: 2 days ago • Promoted

Senior Platform Operations Leader

Coinbase • Honolulu, HI, United States

Full-time

A leading cryptocurrency firm in Honolulu seeks an experienced Senior Platform Operations Partner to manage product operations and drive continuous improvement initiatives.In this role, you will en...Show more

Last updated: 14 days ago • Promoted

Senior Manager, Clinical Technical Operations

Otsuka America Pharmaceutical Inc. • Honolulu, HI, United States

Full-time

The Senior Manager, Clinical Technical Operations within Clinical Operations is responsible for supporting the implementation, integration, and optimization of technical systems and processes that ...Show more

Last updated: 16 days ago • Promoted

Senior Manager, New Product Planning - Oncology

Sumitomo Pharma • Honolulu, HI, United States

Full-time

Japan with operations in the U.With several marketed products and a diverse pipeline of early- to late-stage investigational assets, we aim to accelerate discovery, research, and development to bri...Show more

Last updated: 2 days ago • Promoted

Director of Revenue Management

Crescent Services • Honolulu, HI, United States

Full-time

Uniquely located in the heart of Honolulu, guests have the convenience of the city outside their front door yet surrounded by the beauty of the island through stunning ocean views.At Renaissance Ho...Show more

Last updated: 2 days ago • Promoted

Associate Account Manager

Brown & Brown • Honolulu, HI, United States

Full-time

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers.Brown & Brown is seeking an Associate Account Manager to j...Show more

Last updated: 2 days ago • Promoted